Provider Demographics
NPI:1528111960
Name:RHODEN, SHIRANDA MONIQUE (RPA-C)
Entity type:Individual
Prefix:
First Name:SHIRANDA
Middle Name:MONIQUE
Last Name:RHODEN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:SHIRANDA
Other - Middle Name:MONIQUE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:25 DAVENPORT AVE
Mailing Address - Street 2:2A
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3446
Mailing Address - Country:US
Mailing Address - Phone:917-557-8532
Mailing Address - Fax:
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:RM12121
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-4769
Practice Address - Fax:212-939-3599
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009864363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical